Browsing by Author "Mji, Gubela"
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- ItemThe achievement of community intergration and productivity outcomes by CVA survivors in the Western Cape Metro Health District(Occupational Therapy Association of South Africa, 2012-04) Hassan, Soelaylah A. M.; Visagie, Surona; Mji, GubelaIntroduction: According to the South African National Rehabilitation policy, achieving advanced outcomes such as community integration and productive activity, should be the focus of the rehabilitation services. However, according to the literature, rehabilitation does not often progress beyond basic outcomes such as mobility and self-care. The aim of this study was to describe the achievement of community integration and productive activity outcomes by a group of CVA survivors in the Western Cape Metro Health District. Methods: A descriptive study was carried out. Quantitative data were collected from 57 CVA survivors and caregivers. All these CVA survivors had received in-patient rehabilitation at the Western Cape Rehabilitation Centre (WCRC). Data were collected by means of a medical and demographic questionnaire, the Barthel Index and the Outcome Levels according to Landrum et al. Results: On discharge from in-patient rehabilitation seven (12%) stroke survivors were at level II ie they had achieved only the basic rehabilitation outcomes necessary to preserve long term physiological health, whereas 37 (65%) stroke survivors were discharged at an outcome level III ie ready for residential integration, and 12 (21%) were at level IV ie community integration, and one (2%) at level V (productive activity). Assessment at the time of the study showed a general improvement post discharge, with 21 participants (37%) improving by one or two outcome to achieve community integration and five (9%) achieving the outcome level of productive activity through informal income generating activities. Conclusion: Thirty three (58%) stroke survivors achieved community integration, while six (10%) progressed to employment. One would like to see further progress to employment especially for those participants who were employed before the stroke. Clinicians might be able to assist more stroke survivors to achieve this through using the outcome levels and incorporating the interventions to reach productive activity such as performing work and skills assessments, employer education and assistance with reasonable accommodations in rehabilitation goals.
- ItemAfrican indigenous knowledge and research(AOSIS Publishing, 2013-01) Owusu-Ansah, Frances, E.; Mji, GubelaThis paper seeks to heighten awareness about the need to include indigenous knowledge in the design and implementation of research, particularly disability research, in Africa. It affirms the suitability of the Afrocentric paradigm in African research and argues the necessity for an emancipatory and participatory type of research which values and includes indigenous knowledge and peoples. In the predominantly Western-oriented academic circles and investigations, the African voice is either sidelined or suppressed because indigenous knowledge and methods are often ignored or not taken seriously. This paper posits that to be meaningful and empowering, African-based research must, of necessity, include African thought and ideas from inception through completion to the implementation of policies arising from the research. In this way the work is both empowering and meaningful for context-specific lasting impact.
- ItemThe African network for evidence-to-action on disability : a role player in the realisation of the UNCRPD in Africa(AOSIS Publishing, 2014-04) Kachaje, Rachel; Dube, Kudakwashe; MacLachlan, Malcolm; Mji, GubelaThis African Journal of Disability supplement focuses on papers presented at the third AfriNEAD Symposium in 2011. In this closing editorial, we want to give an overview of the rationale and major modes of operation of the African Network for Evidence- to-Action on Disability (AfriNEAD) with special focus on recommendations made at the 2011 AfriNEAD Symposium. AfriNEAD is guided and informed by the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) for its research themes. The issues that emerged from AfriNEAD 2011 ranged from children and youth with disabilities; education across the lifespan; economic empowerment; the development process in Africa; health, HIV and AIDS and community-based rehabilitation; holistic wellness; to research evidence and utilisation. Disability-related stigma, the value of emancipatory research and the need to recognise a broader scope of valid methodologies were also highlighted.
- ItemBeyond the checklist : understanding rural health vulnerability in a South African context(Taylor & Francis Open, 2016) Vergunst, Richard; Swartz, Leslie; Mji, Gubela; Kritzinge, Janis; Braathen, Stine HellumBackground: Vulnerability in the past has sometimes been measured and understood in terms of checklists or common understanding. It is argued here that vulnerability is a more complex issue than this. Although checklists of vulnerable groups are important, they do not capture the essence and dynamics of vulnerability. Objective : The case of rural health vulnerability in South Africa is discussed to show that classifying people into vulnerable groups does not portray the complexity and intricacies of what it means to have vulnerability. We also wish to show that there are different kinds of vulnerabilities, and the difference between access vulnerability and illness vulnerability is highlighted. Methods : As part of a larger study, this case study is presented to show how vulnerability in a poor rural community in South Africa has to be understood in a contextual and dynamic manner as opposed to a static manner. Results : Family and social dynamics can influence health. For example, fractured families were seen as a vulnerable issue within the community, while being a person with a disability can lead to isolation and callous attitudes towards them. It is these family and social dynamics that lead proximally to vulnerability to ill health. Conclusions : A contextual approach can assist in giving a more layered understanding of vulnerability than a checklist approach can do. Interventions to change health cannot be addressed simply by medical means. Social conditions need to be changed, and part of changing social conditions is the process of assisting those who are isolated or experience themselves as vulnerable to reconnect with others in the community. Poverty leads to social exclusion; social and family inclusion may be key to well-being.
- ItemThe experiences and challenges faced by rehabilitation community service therapists within the South African Primary Healthcare health system(AOSIS Publishing, 2017) Ned, Lieketseng; Cloete, Lizahn; Mji, GubelaBackground: Twenty-two years after the promulgation of a plethora of progressive health policies since 1994, the South African public health system reflects a number of stumbling blocks regarding implementation. Rehabilitation professionals are not sufficiently equipped nor allowed the opportunity to comprehensively implement Primary Healthcare (PHC) from a bottom-up approach, thus engaging communities. Training on addressing social health determinants and their impact on ill-health and health outcomes is inadequate. The inadequate understanding of the advocacy role that rehabilitation professionals could play in addressing social health determinants remains a challenge in healthcare. Rehabilitation, a pillar of PHC, remains poorly understood in terms of its role within the health system. Aim: We argue for rehabilitation as a vehicle for addressing social determinants of health with community service practitioners playing a critical role in addressing the inequities within the healthcare package. Setting: The article reflects the opportunities and challenges faced by rehabilitation community service therapists in the delivery of rehabilitation services in a rural area of the Eastern Cape province of South Africa. Methods: A single case study from the perspective of a researcher was used to explore the experience and reflection of the first author during her community service as an occupational therapist. Results: The case study highlights some existing gaps within the delivery of rehabilitation services in the rural Eastern Cape. A community service package with a specific approach towards addressing social determinants of health for persons with disability at a community level is suggested. Conclusion: Advocating for a rehabilitation service package to shift to community-based levels is critical. It is envisaged that a community-based approach will facilitate an understanding of the barriers faced by persons with disabilities as constituting disability, thus facilitating learning about the disabling consequences of the rural environment coupled with the system as experienced by persons with disabilities.
- ItemExperiences of patients and service providers with out-patient rehabilitation services in a rehabilitation centre in the Western Cape Province(AOSIS Publishing, 2015-12) Kumurenzi, Anne; Goliath, Charlyn; Mji, Gubela; Mlenzana, Nondwe; Joseph, Conran; Statham, Sue; Rhoda, AntheaBackground: Rehabilitation is important for persons with disabilities as it contributes to their sense of autonomy, self-worth and social participation, and improves their quality of life. Improving the quality of rehabilitation services requires the dialogue of patients’ perceptions with those of service providers, in order to recommend informed reform. Objective: The objective was to explore the experiences of persons with physical disabilities and service providers, regarding the multi-disciplinary rehabilitation services provided at a community-based out-patient rehabilitation centre. Methods: A qualitative, exploratory study design was used to collect the data. A focus group was conducted with conveniently selected persons with physical disabilities. Three in-depth interviews were conducted with purposively selected key informants. All ethical considerations were adhered to during the implementation of the study. Results: Patients and service providers had different experiences regarding accessibility to rehabilitation services, and similar experiences with patient education and intensity of rehabilitation. Although the patients experienced that the service providers had sufficient knowledge and skills to manage them, services providers expressed that they lacked certain skills. Conclusions: The experiences expressed highlighted the need to improve rehabilitation services in terms of increasing the capacity of service providers and providing transport services for persons with disabilities.
- ItemAn exploration of burn survivors’ experiences of pressure garment therapy at a tertiary hospital in South Africa(Occupational Therapy Association of South Africa, 2017) Pillay, Rogini; Visagie, Surona; Mji, GubelaIntroduction: Pressure garment therapy is used to treat hypertrophic scars, but adherence to this intervention presents challenges. The aim of the paper was to explore the pressure garment therapy experiences of adult burn survivors. Methods: The experiences of eight purposively sampled participants were explored in a qualitative, phenomenological study. Data were collected by means of semi-structured interviews. Thematic analysis was conducted. Results: Participants described an improvement in the scars, but struggled with adherence to pressure garment therapy. The emotional impact of the burn injury, physical symptoms, the effort of caring for the garments and aesthetic factors created barriers to adherence. Support, inner strength, knowledge, and seeing an improvement facilitated adherence. Conclusion: The findings of the study show that participants perceived pressure garment therapy as beneficial, but several complex factors impacted adherence. A bigger choice in material colours, a person-centred approach to burn management, digital photos of scars to catalogue improvement and the establishment of a counselling network are recommended.
- ItemExploring the health knowledge carried by older Xhosa women in their home situation, with special focus on indigenous knowledge(Stellenbosch : Stellenbosch University, 2013-03) Mji, Gubela; De Villiers, Marietjie Rene; Gibson, Diana; Van Niekerk, Lana; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Family Medicine and Primary Care.ENGLISH ABSTRACT: Rationale: Critical questions have been raised about the overcrowding of primary care services, such as community health centres (CHCs) and clinics in predominantly Xhosa-occupied areas in the Western and Eastern Cape, with clients who present with minor health ailments. Suggestions have been made about the integration and the use of the indigenous health knowledge (IHK) carried by older Xhosa women in the services as a strategy for managing minor health ailments, and as a way of encouraging appropriate health-seeking behaviour. Preliminary studies have reinforced the need for the revival of the IHK that currently is lying dormant within communities. The studies affirm that such knowledge could be an asset if integrated into, and valued by, the Western biomedical model, and could play a major role in contributing towards alleviating the problem of overcrowding in primary care (PC) services. Aim: This study primarily explored and described the IHK carried by older Xhosa women and used in the management of health problems in their home situation. Secondary recommendations were made to key stakeholders regarding the use, retainment and integration of the IHK into PC services. Method: This ethnographic, feminist and emancipatory study used qualitative methods of data collection. Thirty-six (36) older Xhosa women were purposefully selected to participate in four FGDs, to explore the IHK that they used for managing health problems in their home situation. Sixteen (16) in-depth interviews were conducted with the elite older Xhosa women and their family members to validate the findings from the four FGDs. The process of analysis and interpretation was informed by an inductive process of a combination of narrative analysis and the analysis of narratives strategies. Findings: The findings showed that the older Xhosa women possess IHK regarding the management of minor health problems within the home situation. Assessment, treatment strategies and medications were identified. Functionality and observation are mainly used to diagnose and manage illness. This approach also includes monitoring the progress, severity and recovery from illness in the patient. The findings further demonstrated that older Xhosa women were also managing illnesses that could be classified as major. They could clearly distinguish between what was health and what was illness in their village. Distance from health care services had an impact on the health-seeking behaviour of the older Xhosa women, with those closer to health care services wanting all illnesses, even those that could be classified as minor health ailments, to be managed by the health service, and those who were farther away from the hospital appearing to manage complex illnesses, and only referring clients with those illnesses to external health care services quite late. The findings further showed communication and attitudinal problems that existed between the clients and health care providers. Conclusion: Many studies have already challenged the manner in which PHC was implemented in developing countries, as it appeared to focus on the curative approach to disease and left out disease prevention and health promotion. It is within this area that the older Xhosa women appear to express the greatest concern for the health of their homes and villages. The older Xhosa women in the Eastern Cape appear to be struggling with problems of broken family units, and are left behind to struggle to keep the home together, as they lack the necessary resources to do the hard work involved with producing food and building the home and village. In the light of the promise of National Health Insurance and the revitalisation of PHC, the study proposes that the two major national health policies should take cognisance of the IHK utilised by the older Xhosa women, and that there should be a clear plan as to how the knowledge can be supported within a health care systems approach. A rural health model is proposed by the study to do this.
- ItemExploring the inclusion of teaching and learning on assistive products in undergraduate curricula of health sciences faculties at three South African Universities(Taylor and Francis, 2019-12) Visagie, Surona; Mji, Gubela; Scheffler, Elsje; Ohajunwa, Chioma; Seymour, NickyBackground: Providers must be knowledgeable on policy, systems and products to provide a person centred service and prescribe the most appropriate assistive product for each user. Aim: This study aimed to determine to what extent teaching and learning on assistive products are included in undergraduate curricula of the Health science faculties at three universities in the Western Cape Province of South Africa. Methods: Data were gathered through a cross sectional survey. Fifteen programmes were approached of whom eight participated. Information on teaching on assistive products was sourced from purposively identified key informants, through e-mail questionnaires. Descriptive analysis was done. Results: A total of 104 assistive products were included in the eight programmes. Manual wheelchairs were the only product for which teaching was underscored by policy guidelines. Handheld mobility devices and wheelchairs were covered by five programmes. Teaching on assistive products for self-care, participation in domestic life, indoor and outdoor activities, employment and leisure was limited. Thirty seven products listed on the GATE List of 50 were taught by at least one of the programmes. Teaching and examination were theoretical in nature and occurred in professional silos. Clinical exposure was often incidental. For many products none of the four service delivery steps were covered. Conclusion: Assistive products were included in all the participating undergraduate programmes. The range of included products and the level of training were insufficient to prepare graduates to effectively address user’s needs. Newly appointed graduates will require early in-service training to ensure appropriate assistive product service delivery. Implications for rehabilitation: Undergraduate teaching on assistive products is provided in professional silos. Not all products on the GATE APL of 50 are included in under graduate teaching. Teaching does not always ensure a proficiency level that will support graduates to provide an independent AT service.
- ItemExploring the interaction of activity limitations with context, systems, community and personal factors in accessing public health care services : a presentation of South African case studies(AOSIS Publishing, 2017-02) Mji, Gubela; Braathen, Stine H.; Vergunst, Richard; Scheffler, Elsje; Kritzinger, Janis; Mannan, Hasheem; Schneider, Marguerite; Swartz, Leslie; Visagie, SuronaBackground: There are many factors that influence access to public health services, such as the context people live in, the existing health services, and personal, cultural and community factors. People with disabilities (activity limitations), through their experience of health services, may offer a particular understanding of the performance of the health services, thus exposing health system limitations more clearly than perhaps any other health service user. Aim: This article explores how activity limitations interact with factors related to context, systems, community and personal factors in accessing public health care services in South Africa. Setting: We present four case studies of people with disabilities from four low-resource diverse contexts in South Africa (rural, semi-rural, farming community and peri-urban) to highlight challenges of access to health services experienced by people with activity limitations in a variety of contexts. Methods: One case study of a person with disabilities was chosen from each study setting to build evidence using an intensive qualitative case study methodology to elucidate individual and household experiences of challenges experienced by people with activity limitations when attempting to access public health services. In-depth interviews were used to collect data, using an interview guide. The analysis was conducted in the form of a thematic analysis using the interview topics as a starting point. Results: First, these four case studies demonstrate that equitable access to health services for people with activity limitations is influenced by a complex interplay of a variety of factors for a single individual in a particular context. Secondly, that while problems with access to public health services are experienced by everyone, people with activity limitations are affected in particular ways making them particularly vulnerable in using public health services. Conclusion: The revitalisation of primary health care and the introduction of national health insurance by the Health Department of South Africa open a window of opportunity for policy makers and policy implementers to revisit and address the areas of access to public health services for people with activity limitations.
- ItemFactors related to environmental barriers experienced by persons with and without disabilities in diverse African settings(Public Library of Science, 2017-12) Visagie, Surona; Eide, Arne H.; Dyrstad, Karin; Mannan, Hasheem; Swartz, Leslie; Schneider, Marguerite; Mji, Gubela; Munthali, Alister; Khogali, Mustafa; Van Rooy, Gert; Hem, Karl-Gerhard; MacLachlan, MalcolmENGLISH ABSTRACT: This paper explores differences in experienced environmental barriers between individuals with and without disabilities and the impact of additional factors on experienced environmental barriers. Data was collected in 2011–2012 by means of a two-stage cluster sampling and comprised 400–500 households in different sites in South Africa, Sudan Malawi and Namibia. Data were collected through self-report survey questionnaires. In addition to descriptive statistics and simple statistical tests a structural equation model was developed and tested. The combined file comprised 9,307 participants. The Craig Hospital Inventory of Environmental Factors was used to assess the level of environmental barriers. Transportation, the natural environment and access to health care services created the biggest barriers. An exploratory factor analysis yielded support for a one component solution for environmental barriers. A scale was constructed by adding the items together and dividing by number of items, yielding a range from one to five with five representing the highest level of environmental barriers and one the lowest. An overall mean value of 1.51 was found. Persons with disabilities scored 1.66 and persons without disabilities 1.36 (F = 466.89, p < .001). Bivariate regression analyses revealed environmental barriers to be higher among rural respondents, increasing with age and severity of disability, and lower for those with a higher level of education and with better physical and mental health. Gender had an impact only among persons without disabilities, where women report more barriers than men. Structural equation model analysis showed that socioeconomic status was significantly and negatively associated with environmental barriers. Activity limitation is significantly associated with environmental barriers when controlling for a number of other individual characteristics. Reducing barriers for the general population would go some way to reduce the impact of these for persons with activity limitations, but additional and specific adaptations will be required to ensure an inclusive society.
- ItemImpact of post-stroke impairments on activities and participation as experienced by stroke survivors in a Western Cape setting(Occupational Therapy Association of South Africa, 2016) Cawood, Judy; Visagie, Surona; Mji, GubelaENGLISH SUMMARY : Introduction: This paper explores causal connections between impairments, activity limitations and participation restrictions after stroke. Methods: The study population (N=267) of this descriptive study were public health care users, from the eastern sub-district of the Western Cape Metropole, who had a stroke between 1 January 2009 and 31 December 2010. Fifty-three study participants were selected through stratified, proportional, random sampling. Data was collected using the Stroke Impact Scale-3.0; the Modified Barthel Index; the Loewenstein Occupational Therapy Cognitive Assessment and a language screening test. Spearman correlations were used to determine statistical significance. Results: The mean Stroke Impact Scale participation score was 31.3/100. Limb strength (<0.01), visual perception (<0.01), spatial perception (0.02), motor praxis (<0.01), visuomotor organisation (<0.01), and thinking operations (<0.01), impacted participation scores negatively. The mean Modified Barthel Index score was 70.58/100. Limb strength (<0.01), hand function (<0.01), visual perception (<0.01), motor praxis (<0.01), visuomotor organisation (<0.01), and thinking operations (<0.01) impacted Modified Barthel Index scores negatively. Conclusion: Motor, cognitive and perceptual impairments impacted activities and participation negatively. Stroke survivors should receive routine cognitive, perceptual and motor evaluations. The effect of intervention strategies on cognitive and perceptual impairment post-stroke must be studied.
- ItemLearning from doing the EquitAble project : content, context, process, and impact of a multi-country research project on vulnerable populations in Africa(AOSIS Publishing, 2014-10) MacLachlan, Mac; Amin, Mutamad; Mji, Gubela; Mannan, Hasheem; McVeigh, Joanne; McAuliffe, Eilish; Amadhila, Elina; Munthali, Alister; Eide, Arne, H.; Kudakwashe Dube, A.Background: The ‘EquitAble’ project carried out content analyses of policies and collected and analysed qualitative and quantitative data concerning access to health services in Sudan, Malawi, Namibia and South Africa. Our particular concern was to address the situation of people with disabilities, although not in isolation from other marginalised or vulnerable groups. Objectives: This article reports on the content, context, process and impact of project EquitAble, funded by the European Commission Seventh Research Framework Programme, which brought together researchers from Ireland, Norway, South Africa, Namibia, Sudan and Malawi. Method: After the 4-year project ended in February 2013, all members of the consortium were asked to anonymously complete a bespoke questionnaire designed by the coordinating team. The purpose of the questionnaire was to capture the views of those who collaborated on the research project in relation to issues of content, context, process and impact of the EquitAble project. Results: Our results indicated some of the successes and challenges encountered by our consortium. Conclusion: We identified contextual and process learning points, factors often not discussed in papers, which typically focus on the reporting of the ‘content’ of results.
- ItemLessons from the pilot of a mobile application to map assistive technology suppliers in Africa(AOSIS, 2018) Visagie, Surona J.; Matter, Rebecca; Kayange, George M.; Chiwaula, Mussa; Harniss, Mark; Mji, Gubela; Scheffler, ElsjeA pilot project to develop and implement a mobile smartphone application (App) that tracks and maps assistive technology (AT) availability in southern Africa was launched in Botswana in 2016. The App was developed and tested through an iterative process. The concept of the App (AT-Info-Map) was well received by most stakeholders within the pilot country, and broader networks. Several technical and logistical obstacles were encountered. These included high data costs; difficulty in accessing AT information from the public healthcare sector, the largest supplier of AT; and the high human resource demand of collecting and keeping up-to-date device-level information within a complex and fragmented supply sector that spans private, public and civil society entities. The challenges were dealt with by keeping the data burden low and eliminating product-level tracking. The App design was expanded to include disability services, contextually specific AT categories and make navigation more intuitive. Long-term sustainability strategies like generating funding through advertisements on the App or supplier usage fees must be explored. Outreach and sensitisation programmes about both the App and AT in general must be intensified. The project team must continually strengthen partnerships with private and public stakeholders to ensure ongoing project engagement. The lessons learnt might be of value to others who wish to embark on initiatives in AT and/or implement Apps in health or disability in southern Africa and in low-resourced settings around the world.
- ItemThe prevalence of burnout amongst therapists working in private physical rehabilitation centers in South Africa : a descriptive study(Occupational Therapy Association of South Africa, 2014-08) Du Plessis, Theresa; Visagie, Surona; Mji, GubelaHealth care service providers are at risk of burnout due to the nature of their jobs and their personalities. No research has been published on the prevalence and causes of burnout in therapists working in physical rehabilitation units in South Africa. This study aimed to determine the prevalence of burnout and identify causes in therapists working in physical rehabilitation in South Africa. A descriptive, quantitative study was done. Study participants comprised 49 therapists (14 occupational therapists, 13 physiotherapists, 7 therapy assistants, 4 social workers, 1 dietician, 5 speech therapists and 5 psychologists) from six private rehabilitation units in South Africa. No sampling was done. The prevalence of burnout was established with the Maslach Burnout Inventory Manual (MBI). Demographic and employment data were gathered through a questionnaire. MBI scores were categorised as high, moderate or low on the subscales of emotional exhaustion, depersonalisation and decreased personal accomplishment. The maximum likelihood and chi-squared tests were used for statistical analysis. A p value of <0.05 was deemed statistically significant. The prevalence of burnout was high: 57.14% suffered from emotional exhaustion, 20.40% from depersonalisation and 38.77% from decreased personal accomplishment. Not having children (p = 0.029), poor coping skills (0.031), an overwhelming workload (0.039),and poor work environment (0.021) had a statistically significant relationship with emotional exhaustion. An overwhelming patient load (0.012), seldom achievable deadlines (0.036), postponing contact with patients (0.02) and poor work environment (0.04) had a statistically significant relationship with depersonalisation. Male gender (0.023), not having children (0.038), less than four years of tertiary education (0.036), low income levels (0.022), high administration load (0.003) and postponing contact with patients (0.011) had a statistically significant relationship with personal accomplishment. Ensuring on-going support emotional support and job satisfaction of therapists is important if an institution is to provide continuing quality rehabilitation services.
- ItemPromoting good policy for leadership and governance of health related rehabilitation : a realist synthesis(BioMed Central, 2016-08-24) McVeigh, Joanne; MacLachlan, Malcolm; Gilmore, Brynne; McClean, Chiedza; Eide, Arne H.; Mannan, Hasheem; Geiser, Priscille; Duttine, Antony; Mji, Gubela; McAuliffe, Eilish; Sprunt, Beth; Amin, Mutamad; Normand, CharlesENGLISH SUMMARY : Good governance may result in strengthened performance of a health system. Coherent policies are essential for good health system governance. The overall aim of this research is to provide the best available scientific evidence on principles of good policy related leadership and governance of health related rehabilitation services in less resourced settings. This research was also conducted to support development of the World Health Organization’s (WHO) Guidelines on health related rehabilitation. Methods: An innovative study design was used, comprising two methods: a systematic search and realist synthesis of literature, and a Delphi survey of expert stakeholders to refine and triangulate findings from the realist synthesis. In accordance with Pawson and Tilley’s approach to realist synthesis, we identified context mechanism outcome pattern configurations (CMOCs) from the literature. Subsequently, these CMOCs were developed into statements for the Delphi survey, whereby 18 expert stakeholders refined these statements to achieve consensus on recommendations for policy related governance of health related rehabilitation. Results: Several broad principles emerged throughout formulation of recommendations: participation of persons with disabilities in policy processes to improve programme responsiveness, efficiency, effectiveness, and sustainability, and to strengthen service-user self-determination and satisfaction; collection of disaggregated disability statistics to support political momentum, decision-making of policymakers, evaluation, accountability, and equitable allocation of resources; explicit promotion in policies of access to services for all subgroups of persons with disabilities and service-users to support equitable and accessible services; robust inter-sectoral coordination to cultivate coherent mandates across governmental departments regarding service provision; and ‘institutionalizing’ programmes by aligning them with preexisting Ministerial models of healthcare to support programme sustainability. Conclusions: Alongside national policymakers, our policy recommendations are relevant for several stakeholders, including service providers and service-users. This research aims to provide broad policy recommendations, rather than a strict formula, in acknowledgement of contextual diversity and complexity. Accordingly, our study proposes general principles regarding optimal policy related governance of health related rehabilitation in less resourced settings, which may be valuable across diverse health systems and contexts.
- ItemA protocol for the methodological steps used to evaluate the alignment of rehabilitation services in the Western Cape, South Africa with the National Rehabilitation Policy(BioMed Central, 2017-03) Mji, Gubela; Rhoda, Anthea; Statham, Sue; Joseph, ConranENGLISH SUMMARY : Background: Rehabilitation medicine plays an integral part in attainment of optimal functioning after injury or disease. The National Rehabilitation Policy of South Africa (NRP) (2000) highlights the need for access to professional health care services, redistribution and optimal utilisation of resources and research in the field of disability and rehabilitation. The government further ratified the Convention on the Rights of Persons with Disabilities (CRPD) (2007), which validate the urgency in advancing the agenda of persons with disabilities. This paper outlines the methodological plan for evaluating rehabilitation services in the Western Cape, South Africa against the aims and objectives of the NRP as well as its principles and concepts. The evaluation process further focused on specific articles in the CRPD that were aligned with disability, health and rehabilitation. Methods/Design: A mixed-method design was used to evaluate the alignment of rehabilitation services with the NRP in the Western Cape. Four rehabilitation study settings were selected to ensure that both inpatient and outpatient rehabilitation levels of care were covered at different contexts (rural and peri-urban). The sites were checked for the most prevalent rehabilitation-related conditions to ensure the identification of suitable instruments for measuring rehabilitation outcomes. Each study setting was linked to two researchers with one exploring the rehabilitation organizational structure of the sites and the other exploring the client outcomes after receiving rehabilitation services. Patients were evaluated at baseline and discharge, within seven days after admission and seven days prior to discharge. The evaluation was based on the rehabilitation organizational capacity to provide patient-oriented rehabilitation and the measurement of rehabilitation outcomes. Kaplan’s framework of organisational capacity was used in the context of each study setting. For the measurement of service users’ outcomes, the International Classification of Functioning, Disability and Health was used (ICF). Standardised outcome measures were adopted for the domains of impairment, activity and participation. The World Health Organisation Community-Based Rehabilitation guidelines were used as guiding principles and concepts as suggested in the NRP. Discussion: This is a groundbreaking methodological exploration that offers both study methods and instruments to measure rehabilitation services at both in-patient and out-patient rehabilitation services.
- ItemA study of human resource competencies required to implement community rehabilitation in less resourced settings(BioMed Central, 2017-12) Gilmore, Brynne; MacLachlan, Malcolm; McVeigh, Joanne; McClean, Chiedza; Carr, Stuart; Duttine, Antony; Mannan, Hasheem; McAuliffe, Eilish; Mji, Gubela; Eide, Arne H; Hem, Karl-Gerhard; Gupta, NeeruBackground: It is estimated that over one billion persons worldwide have some form of disability. However, there is lack of knowledge and prioritisation of how to serve the needs and provide opportunities for people with disabilities. The community-based rehabilitation (CBR) guidelines, with sufficient and sustained support, can assist in providing access to rehabilitation services, especially in less resourced settings with low resources for rehabilitation. In line with strengthening the implementation of the health-related CBR guidelines, this study aimed to determine what workforce characteristics at the community level enable quality rehabilitation services, with a focus primarily on less resourced settings. Methodology: This was a two-phase review study using (1) a relevant literature review informed by realist synthesis methodology and (2) Delphi survey of the opinions of relevant stakeholders regarding the findings of the review. It focused on individuals (health professionals, lay health workers, community rehabilitation workers) providing services for persons with disabilities in less resourced settings. Results: Thirty-three articles were included in this review. Three Delphi iterations with 19 participants were completed. Taken together, these produced 33 recommendations for developing health-related rehabilitation services. Several general principles for configuring the community rehabilitation workforce emerged: community-based initiatives can allow services to reach more vulnerable populations; the need for supportive and structured supervision at the facility level; core skills likely include case management, social protection, monitoring and record keeping, counselling skills and mechanisms for referral; community ownership; training in CBR matrix and advocacy; a tiered/teamwork system of service delivery; and training should take a rights-based approach, include practical components, and involve persons with disabilities in the delivery and planning. Conclusion: This research can contribute to implementing the WHO guidelines on the interaction between the health sector and CBR, particularly in the context of the Framework for Action for Strengthening Health Systems, in which human resources is one of six components. Realist syntheses can provide policy makers with detailed and practical information regarding complex health interventions, which may be valuable when planning and implementing programmes.
- ItemSuitability of "guidelines for screening of prosthetic candidates : lower limb" for the Eastern Cape, South Africa: a qualitative study(AOSIS, 2018) Mduzana, Luphiwo L.; Visagie, Surona; Mji, GubelaBackground: Major lower limb amputation has a severe impact on functional mobility. Mobility can be salvaged with a prosthesis, but this is not always the best option. It is often difficult to decide whether to refer someone for a prosthesis or not. A prosthetic screening tool ‘Guidelines for Screening of Prosthetic Candidates: Lower Limb’ was developed and is used for prosthetic prescription in parts of the Western Cape province of South Africa. Objectives: This study aimed to explore the suitability of the tool ‘Guidelines for Screening of Prosthetic Candidates: Lower Limb’ for use in the Eastern Cape province of South Africa. Method: A qualitative study was conducted with conveniently sampled occupational therapists (OTs) (n = 10), physiotherapists (PTs) (n = 12) and prosthetists (n = 6) in government employment in the Buffalo City Metro Municipality. Participants were trained in the use of the tool and used it for four weeks with patients. Their experiences of the tool were assessed through three focus group discussions with emergent themes being identified during inductive data analysis. Findings: Participants indicated that the tool could assist with prosthetic prescription, goal setting, communication and teamwork. They thought that the tool was multidisciplinary in nature, comprehensive and practical. Findings showed a lack of teamwork in this study setting. Resistance to change and a lack of time might also hamper implementation of the tool. Conclusion: The tool can assist with managing the backlog for prostheses and to guide prosthetic prescription in the Eastern Cape province. Clinical implications: A prosthesis can help to salvage functional mobility after lower limb amputation. However, not all people who had above knee amputation manage to walk with a prosthesis. The tool reported on in this article provides information that can guide prosthetic prescription and rehabilitation goals.
- ItemWith or without us? : an audit of disability research in the Southern African region(AOSIS Publishing, 2014-06) McKenzie, Judith; Mji, Gubela; Gcaza, SiphokaziBackground: Disability research in the global South has not received significant critical consideration as to how it can be used to challenge the oppression and marginalisation of people with disabilities in low-income and middle-income countries. The Southern Africa Federation of the Disabled (SAFOD) embarked on a programme to use research to influence policy and practice relating to people with disabilities in Southern Africa, and commissioned an audit on research expertise in the region. In this article, a research audit is reported on and situated in a framework of emancipatory research. Objectives: This article sets out to describe a preliminary audit of disability research in the southern African region and to draw conclusions about the current state of disability research in the region and make recommendations. Method: The research method entailed working with disability researchers in the ten SAFOD member countries and utilising African disability networks hosted on electronic media. Disability researchers working in the region completed 87 questionnaires, which were reviewed through a thematic analysis. Results: The discussion of results provides a consideration of definitions of disability; the understanding of disability rights, research topics and methodologies; the participation of people with disabilities in research; and the challenges and opportunities for using research to inform disability activism. Conclusion: The conclusion highlights critical issues for future research in the region, and considers how a disability researcher database can be used as a tool for disability organisations to prioritise research that serves a disability rights agenda.